Rabies Rabies byAngie Genesi Disease Rabies is a disease caused by a virus that belongs to the Rhabdoviridae Family and the Lyssavirus genus. Reservoirs Rabies virus is a zoonoses, which is carried by mammals in particular. The most common reservoirs are dogs, bats, cats, skunks, raccoons and foxes, although any mammal can contract the disease. In the US, most cases of Rabies are contracted through wildlife not domestic animals. Of the few cases in the US each year, bats are responsible for over half. Worldwide, dogs are the most common transmitter of Rabies to humans. (11) Rabies is present in the saliva of rabid animals and it is possible to acquire rabies through open wounds and mucous membranes. It is extremely rare, but possible to get the infection through aerosolized transmission such as in laboratories or caves.(11) General Characteristics of MO Rabies is a bullet shaped, RNA virus that is about 400nm long.

The virus is a negative strand RNA virus, which means it must carry RNA polymerase to transcribe a positive strand RNA, which can code for its five proteins.(9) The viral envelopeï¿½s surface is covered in glycoprotein spikes that may aid in adherence to cell surface proteins. (3,9) Key tests for identification It is possible, but difficult to confirm rabies ante-mortem. A combination of tests is required to diagnose rabies in a living human.(4) The Fluorescent Antibody Test can be used to identify isolated viral samples as positive. This is the most common test done on animals, and is much more accurate when it is done post-mortem. (2,4) Reverse Transcriptase PCR can be used to identify the disease through viral RNA, however these often produce false positives. (2) Serological tests can be used to identify rabies, but are of little use since the development of rabies specific antibodies occurs well after the onset of symptoms. (2) Signs and Symptoms Animals: There are two types of rabies symptoms in animals. Symptoms attributed to ï¿½dumb Rabiesï¿½ include paralysis, depression, and loss of fear.

Symptoms indicative of ï¿½furious Rabiesï¿½ are better known and include aggression, indiscriminate attacking, and self mutilation. (11,12) Humans: Symptoms for rabies can appear anywhere from 30 days to 6 months after exposure. The first wave of symptoms is very general and includes malaise, fever, sore throat, fatigue, muscle aches, and irritability. Pain and stinging emanating from the original infection are early rabies specific symptoms. As the disease progresses, symptoms become more specific. These can include a high fever, agitation, seizures, hallucinations, hydrophobia, irregular breathing, and coma. More rarely a progressive paralysis develops that leads to death.(4,9,11) Historical Information Rabies is one of the oldest documented diseases in the world. The Sanskrit word ï¿½rabhasï¿½ means ï¿½to do violenceï¿½. The first documentation of rabies can be traced back to 23rd century Babylon.(1) The first vaccine for rabies was developed by Louis Pasteur. It was successfully administered to the victim of a rabid dog attack in 1885.

Pasteur also recognized from the characteristics of the disease that the etiological agent was a virus. This was confirmed in 1936, when the virus was first grown in a lab. (8) Virulence There have only been 6 documented survivors of rabies after the onset of symptoms and only one person has survived that did not receive the post-exposure vaccine.(7) The virus enters the body and attaches to nerve and muscle cells and enters a period of replication. No symptoms are present at this time. After the incubation period, the virus travels up the nerve axons and makes its way into the brain tissue, which causes encephalitis. At this point the disease is too far along to treat with vaccines. The disease then makes its way into the salivary glands and other sites around the body. (9) Hydrophobia - definition of hydrophobia by The Free Dictionary Hydrophobia - definition of hydrophobia by The Free Dictionary hy·dro·pho·bi·a (hī′drə-fō′bē-ə) 1. An abnormal fear of water. 2. Rabies.

[Sense 2, from the fact that persons suffering from rabies refuse water because of painful throat spasms .] hydrophobia n 1. (Pathology) another name for rabies 2. (Psychiatry) a fear of drinking fluids, esp that of a person with rabies, because of painful spasms when trying to swallow. Compare aquaphobia hy•dro•pho•bi•a (ˌhaɪ drəˈfoʊ bi ə) 2. an abnormal or unnatural dread of water. [1540–50; < Late Latin < Greek hydrophobía] hy·dro·pho·bi·a (hī′drə-fō′bē-ə) See rabies . Word History Hydrophobia is an older term for the disease rabies, and it means "fear of water." Because of this name, many people think that rabies makes one afraid of water. In fact, this is not the case (although rabies does cause mental confusion of other kinds).

The name hydrophobia comes from the fact that animals and people with rabies get spasms in their throat muscles that are so painful that they cannot eat or drink, and so will refuse water in spite of being very thirsty. hydrophobia 1. hydrophobia - a symptom of rabies in humans consisting of an aversion to swallowing liquids symptom - (medicine) any sensation or change in bodily function that is experienced by a patient and is associated with a particular disease 2. hydrophobia - a morbid fear of water simple phobia - any phobia (other than agoraphobia) associated with relatively simple well-defined stimuli 3. hydrophobia - an acute viral disease of the nervous system of warm-blooded animals (usually transmitted by the bite of a rabid animal); rabies is fatal if the virus reaches the brain zoonosis , zoonotic disease - an animal disease that can be transmitted to humans Translations hy·dro·pho·bi·a n. hidrofobia. 1. temor excesivo al agua; 2. pop. rabia. trastorno trasmitido por un animal infestado. hydrophobia n hidrofobia, terror m al agua (esp.

en los rabiosos) Want to thank TFD for its existence? Tell a friend about us , add a link to this page, or visit the webmaster's page for free fun content . Link to this page: View in context Coast-road to Coquimbo -- Great Loads carried by the Miners -- Coquimbo -- Earthquake -- Step-formed Terrace -- Absence of recent Deposits -- Contemporaneousness of the Tertiary Formations -- Excursion up the Valley -- Road to Guasco -- Deserts -- Valley of Copiapo -- Rain and Earthquakes -- Hydrophobia -- The Despoblado -- Indian Ruins -- Probable Change of Climate -- River-bed arched by an Earthquake -- Cold Gales of Wind -- Noises from a Hill -- Iquique -- Salt Alluvium -- Nitrate of Soda -- Lima -- Unhealthy Country -- Ruins of Callao, overthrown by an Earthquake -- Recent Subsidence -- Elevated Shells on San Lorenzo, their decomposition -- Plain with embedded Shells and fragments of Pottery -- Antiquity of the Indian Race.

View in context A lock-jaw that bends a man's head back to his heels; hydrophobia that makes him bark at his wife and babes; insanity that makes him eat grass; war, plague, cholera, famine, indicate a certain ferocity in nature, which, as it had its inlet by human crime, must have its outlet by human suffering. Disease Outbreak Control Division | Rabies (hydrophobia) Disease Outbreak Control Division Rabies (hydrophobia) What is rabies? Rabies is a very serious disease caused by a virus that affects wild animals, but humans can also become infected. Unless rabies infection is treated promptly, serious brain damage and death can result. Most deaths from rabies occur in developing countries where prompt medical attention and preventive vaccinations are not readily available. Hawaii is the only state in the United States that is free of rabies. How do you get it? Rabies is usually spread to humans through the bites of rabid (rabies-diseased) animals. You can also get rabies when a scratch or fresh break in the skin is directly exposed the saliva from a rabid animal. All warm-blooded mammals, including man, can get rabies.

On the US mainland, wild animals that are most often associated with rabies include skunks, foxes, raccoons, and bats. What are the symptoms of rabies? The early symptoms of rabies include malaise, alternating periods of irritability and anxiety, headache, fever, and sometimes, itching or pain at the site of the bite. Rabies can lead to numbness or paralysis, spasms of the throat muscles, seizures, mental confusion, coma, and death. When do symptoms start? The symptoms usually start 2 to 8 weeks after exposure to a rabid animal. Rarely, it can take as few as 5 days or more than a year for symptoms to appear. What is the treatment for rabies? There is no treatment for rabies after symptoms start, and the disease is almost always fatal. However, doctors can prescribe medicines (called postexposure prophylaxis, or PEP) to be given after exposure and before symptoms begin that can prevent the disease from progressing. After an animal bite, immediately and carefully cleanse the entire site of the bite or wound with lots of soap and water. See a doctor immediately to determine whether PEP is indicated.

What happens if you are exposed to rabies and don’t get treated? If left untreated, rabies is almost always fatal. However, exposure to a rabid animal does not always result in the disease. When rabies is suspected, getting immediate PEP can be effective in preventing disease. How can you keep from getting rabies? Cleanse animal bites or wounds immediately with lots of soap and water. If rabies is suspected, especially in an area where rabies is a problem, promptly seek the advice of a doctor, the Department of Health, or the local health authority. Avoid all wild animals, especially those acting strangely. In areas where rabies is found, vaccinate pets to protect them from getting rabies. For more information, see the CDC’s website. About Us Rabies | Wisconsin Department of Health Services Wisconsin Rabies Prevention flowchart (Rabies algorithm) Animal bite management and potential rabies exposures in humans One of the most effective ways to prevent rabies infection is immediate, thorough cleansing of the animal bite or scratch wounds with liberal amounts of soap and water for 10-15 minutes.

It is important for bite victims to notify their local health department (or local law enforcement when public health staff are unavailable) whenever a bite occurs to ensure that the biting animal is appropriately and legally observed or tested for rabies. It is also vital not to release or destroy a biting animal until a public health official or an animal control officer is consulted. The victim's physician should also be notified promptly. In most instances, observation or testing of the biting animal will rule out the possibility of rabies and will therefore eliminate any need for the bite victim to undergo the series of injections. If circumstances of the exposure warrant it, however, a physician will administer preventive medications (called post-exposure prophylaxis) to the bite victim. This preventive treatment consists of an injection of rabies immune globulin immediately, and four doses of the rabies vaccine given over the course of 14 days. The vaccine is injected in the arm, similar to a tetanus shot. Click here for details on the preventive post-exposure regimen . Exposures to bats are worrisome because some people with very minor exposures to bats have contracted rabies.

If there has been any possibility of physical contact with a bat, even without a known bite, the animal should be safely captured and held until a public health official or a physician can be consulted. It should be noted that domestic animals that are exposed to rabies constitute a very real threat to their human owners, particularly if the animal is unvaccinated. Prevention Measures Exposure to rabies may be minimized by the following measures: Eliminate stray dogs and cats and enforce leash laws. Vaccinate pet dogs, cats, ferrets, and livestock against rabies. Stay away from all wild animals, especially those acting abnormally. Teach your children not to approach any unfamiliar animals. Do not keep exotic or wild animals as pets, regardless of how young or cute they are. Exclude bats from living quarters by keeping screens in good repair and by closing any small openings that could allow them to enter. Persons traveling to developing countries in which rabies is highly prevalent, or persons who are at ongoing risk of possible rabies exposure (e.g., veterinarians, animal control officers), should ask their doctor about receiving the PRE-exposure rabies vaccinations.

Consultation resources Members of the public should contact their local public health department (county or municipal) and their health care provider regarding animal bite/rabies concerns. During off-hours, animal bite calls may be handled by local law enforcement personnel. The Communicable Disease Epidemiology Section of the Wisconsin Division of Public Health offers consultation on situations involving potential human exposures to rabies. Local health department staff or health care providers can call 608-267-9003 during regular office hours, or the DPH emergency answering service at 608-258-0099 on nights and weekends, in order to consult with an epidemiologist. Questions regarding the submission of specimens for rabies testing to the State Laboratory of Hygiene, or about the reporting of test results, can be addressed to the SLH Customer Service at 800-862-1013 during regular office hours. To consult about potential animal exposures to rabies, callers can contact Dr. Yvonne Bellay at the Wisconsin Division of Animal Health at 608-224-4888. It should be noted that domestic animals that are exposed to rabies constitute a very real threat to their human owners.

Accordingly, Wisconsin statute 95.21 also addresses animal exposures to rabies and defines circumstances under which such an animal is subject to quarantine. Animal bite management from the perspective of rabies prevention: Rabies-Topic Overview Topic Overview Credits What is rabies? Rabies is an infection caused by a virus. It affects the brain and spinal cord ( central nervous system ) of mammals, including humans. It is nearly always deadly if not treated before symptoms begin. Animals that are infected with rabies-rabid animals-can spread the disease through their saliva or through brain tissue. It is rare for people in the United States or Canada to get rabies. It is more common in developing nations. How do you get rabies? People usually get rabies when a rabid animal bites them. People in the U.S. and Canada are most likely to get rabies from bats. 1 People in many other countries are most likely to get rabies from dog bites . 2 , 3 Bats, raccoons, skunks, foxes, and coyotes are the animals most likely to have rabies in the U.S. and Canada. Small mammals such as mice and squirrels almost never have rabies.

Sometimes the rabies virus can spread to pets, such as dogs, cats, and ferrets. But household pets rarely get rabies, because most of them get rabies vaccines . Pets that stay indoors are very unlikely to get rabies. It's possible to get rabies even when you don't see an animal bite. For example, bat bites or scratches may be so small that you don't notice them. If you or your children come in direct contact with a bat, or if you find a bat in a closed room with a sleeping person, call your doctor right away. People also can get rabies by handling animals with rabies or inhaling the virus, but these cases are rare. What are the symptoms? Signs of rabies in animals may include drooling, foaming at the mouth , or paralysis . A pet with rabies also may behave differently than usual, such as acting shy when the pet usually is friendly. A wild animal with rabies may have no fear of humans. Rabies in humans begins with symptoms such as fever, cough , or sore throat . Later, symptoms become more serious and can include restlessness, hallucinations , and seizures . The final stage is coma and death.

If you think you've been exposed to the rabies virus, it's very important to get medical care before symptoms begin. If symptoms appear, it's too late for a cure, and the infection will probably lead to death. The time from exposure to the virus until symptoms appear usually is 2 to 3 months. In rare cases, it may be shorter or much longer. Continued How is rabies treated? The treatment for someone who has been exposed to rabies is a series of shots known as postexposure prophylaxis (PEP). These shots help the body's immune system destroy the disease in its early stages. Getting PEP before symptoms appear usually prevents infection, and you are likely to recover. In the U.S. and Canada, PEP has two parts, usually given at the same time: A shot of human antibodies against rabies, called human rabies immunoglobulin (HRIG) The rabies vaccination series Some vaccines that aren't approved for use in the U.S. or Canada are used in developing countries. The World Health Organization (WHO) approves of these vaccines . 4 But they may cause worse reactions than newer vaccines. If you are exposed to rabies outside of the U.S.

or Canada and have any choice, request HDCV (human diploid cell vaccine), RVA (rabies vaccine, adsorbed), or PCEC (purified chick embryo cell culture). If these aren't available, it is better to accept one of the other vaccines than to get no vaccine at all. As soon as you can return home, ask your doctor about whether you should get any more vaccines. What should you do if you think you have been exposed to rabies? First, wash the animal bite, scratch, or open sore with soap and water. Then call your doctor and local health department right away. They can advise you on what to do next. If you've been bitten by or exposed to an animal at low risk for having rabies, such as a pet, the animal will be captured and watched for signs of rabies. If there's a chance that the animal is rabid, you will start getting shots right away. If you've been bitten by or exposed to an animal at high risk for having rabies, you will start getting shots right away. If possible, the animal will be watched for signs of rabies or will be killed for testing.

If it turns out that the animal doesn't have rabies, you can stop the shots. If an animal shows signs of rabies but can't be captured for testing, it often is assumed to be rabid. Continued Rabies, hydrophobia Rabies (also known as Hydrophobia) Rabies Facts Rabies CANNOT be diagnosed visually. Only a laboratory can determine if an animal is rabid. House cats are a significant threat for rabies. Opossums have been known to contract rabies, though it is extremely rare. Rabies attacks the nervous system. Rabies vaccination is not as painful as it used to be but it still hurts the wallet. Avoid damaging the brains of animals that are in need of rabies testing. This means no tennis racquets when dealing with bats. RESOURCES CDC - The Rabies Virus - Rabies ShareCompartir The Rabies Virus Rabies virus belongs to the order Mononegavirales, viruses with a nonsegmented, negative-stranded RNA genomes.

Within this group, viruses with a distinct "bullet" shape are classified in the Rhabdoviridae family, which includes at least three genera of animal viruses, Lyssavirus, Ephemerovirus, and Vesiculovirus. The genus Lyssavirus includes rabies virus, Lagos bat, Mokola virus, Duvenhage virus, European bat virus 1 & 2 and Australian bat virus. Structure Rabies virions are bullet-shaped with 10-nm spike-like glycoprotein peplomers covering the surface. The ribonucleoprotein is composed of RNA encased in nucleoprotein -(), phosphorylated or phosphoprotein -Illistration of virus, and polymerase -virus. Rhabdoviruses are approximately 180 nm long and 75 nm wide. The rabies genome encodes five proteins: nucleoprotein (N), phosphoprotein (P), matrix protein (M), glycoprotein (G) and polymerase (L). All rhabdoviruses have two major structural components: a helical ribonucleoprotein core (RNP) and a surrounding envelope.

In the RNP, genomic RNA is tightly encased by the nucleoprotein. Two other viral proteins, the phospoprotein and the large protein (L-protein or polymerase) are associated with the RNP. The glycoprotein forms approximately 400 trimeric spikes which are tightly arranged on the surface of the virus. The M protein is associated both with the envelope and the RNP and may be the central protein of rhabdovirus assembly. The basic structure and composition of rabies virus is depicted in the longitudinal diagram below. The cross-sectional diagram demonstrates the concentric layers: envelope membrane bilayer, M protein, and tightly coiled encased genomic RNA. Rabies is an RNA virus. The genome encodes 5 proteins designated as N, P, M, G, and L. The order and relative size of the genes in the genome are shown in the figure below. The arrangement of these proteins and the RNA genome determine the structure of the rabies virus. Replication The rabies virus genome is single-stranded, antisense, nonsegmented, RNA of approximately 12 kb.

There is a leader-sequence (LDR) of approximately 50 nucleotides, followed by N, P, M, G, and L genes. The fusion of the rabies virus envelope to the host cell membrane (adsorption) initiates the infection process. The interaction of the G protein and specific cell surface receptors may be involved. After adsorption, the virus penetrates the host cell and enters the cytoplasm by pinocytosis (via clathrin-coated pits). The virions aggregate in the large endosomes (cytoplasmic vesicles). The viral membranes fuse to the endosomal membranes, causing the release of viral RNP into the cytoplasm (uncoating). Because lyssaviruses have a linear single-negative-stranded ribonucleic acid (RNA) genome, messenger RNAs (mRNAs) must be transcribed to permit virus replication. 1: Adsorption (receptors and virion interation). 2: Penetration (virus entry). 3: Uncoating (envelope removal). 4. Transcription (synthesis of mRNAs). 5. Translation (Synthesis of structural proteins). 6. Processing (G-protein gycosylation). 7.

Replication (production of genomic RNA from intermediate strand. 8. Assembly. 9: Budding (complete virions). A viral-encoded polymerase (L gene) transcribes the genomic strand of rabies RNA into leader RNA and five capped and polyadenylated mRNAs, which are translated into proteins. Translation, which involves the synthesis of the N, P, M, G and L proteins, occurs on free ribosomes in the cytoplasm. Although G protein synthesis is initiated on free ribosomes, completion of synthesis and glycosylation (processing of the glycoprotein), occurs in the endoplamsic reticulum (ER) and Golgi apparatus. The intracellular ratio of leader RNA to N protein regulates the switch from transcription to replication. When this switch is activated, replication of the viral genome begins. The first step in viral replication is synthesis of full-length copies (postive strands) of the viral genome. When the switch to replication occurs, RNA transcription becomes "non-stop" and stop codons are ignored. The viral polymerase enters a single site on the 3’ end of the genome, and proceeds to synthesize full-length copies of the genome.

These positive strands of rabies RNA serve as templates for synthesis of full-length negative strands of the viral genome. During the assembly process, the N-P-L complex encapsulates negative-stranded genomic RNA to form the RNP core, and the M protein forms a capsule, or matrix, around the RNP. The RNP-M complex migrates to an area of the plasma membrane containing glycoprotein inserts, and the M-protein initiates coiling. The M-RNP complex binds with the glycoprotein, and the completed virus buds from the plasma membrane. Within the central nervous system (CNS), there is preferential viral budding from plasma membranes. Conversely, virus in the salivary glands buds primarily from the cell membrane into the acinar lumen. Viral budding into the salivary gland and virus-induced aggressive biting-behavior in the host animal maximize chances of viral infection of a new host. Hydrophobia - RightDiagnosis.com Hydrophobia Hydrophobia (medical condition): An infectious disease that can affect any mammal including... more » See also: Hydrophobia: a symptom of rabies in humans consisting of an aversion to swallowing liquids.

Source: WordNet 2.1 These medical condition or symptom topics may be relevant to medical information for Hydrophobia: SYN » Treatments for Rabies Hydrophobia: Related Diseases Hydrophobia: Hydrophobia is listed as a type of (or associated with) the following medical conditions in our database: Raccoon bite - 44% of USA rabies cases Skunk bite - 28.5% of USA rabies cases Bat bite - 12.5% of USA rabies cases Fox bite (type of Animal bite ) - 5.5% of USA rabies cases See full list of 10 causes of Hydrophobia (Rabies) Symptoms of Hydrophobia (Rabies) See full list of 65 symptoms of Hydrophobia (Rabies) Treatments for Hydrophobia (Rabies) Treatments for Hydrophobia (Rabies) include: Human rabies immunoglobulin (HRIG) shots - a form of rapid passive immunization; used before starting rabies shots. Rabies vaccine shots - active immunization; typically a series of 5 shots; there are various types of rabies shots.

See full list of 11 treatments for Hydrophobia Treatment of Hydrophobia: For more treatment information about Hydrophobia, see treatment of Rabies (Hydrophobia) Hydrophobia: Article Excerpts about Rabies Rabies, NIAID Fact Sheet: NIAID (Excerpt) Rabies is an acute and deadly viral infection of the central nervous system. It is one... (Source: excerpt from Rabies, NIAID Fact Sheet: NIAID ) What is rabies?: DVRD (Excerpt) Rabies is a disease that affects wild animals, domestic animals (like pets and livestock), and humans. It is caused by a ... (Source: excerpt from What is rabies?: DVRD ) Hydrophobia as a Symptom Hydrophobia (symptom): rabies also known as "hydrophobia" is a viral zoonotic neuroinvasive... more » Hydrophobia (symptom): See Hydrophobia (symptom information). More information on symptom: Hydrophobia : Medical Mystery: Only One Person Has Survived Rabies without Vaccine--But How? - Scientific American Medical Mystery: Only One Person Has Survived Rabies without Vaccine--But How?

ScientificAmerican.com talks with the first known survivor of rabies four years later By Jordan Lite on October 8, 2008 Advertisement | Report Ad Four years after she nearly died from rabies, Jeanna Giese is being heralded as the first person known to have survived the virus without receiving a preventative vaccine. But Giese (pronounced Gee-See) says she would gladly share that honor with others if only doctors could show that the treatment used to save her could spare other victims as well. "They shouldn't stop 'till it's perfected," said Giese, now 19, during a recent interview about physicians' quest to refine the technique that may have kept her alive. Giese's wish may come true. Another young girl infected with rabies is still alive more than a month after doctors induced a coma to put her symptoms on hold, just as they did with Giese. Yolanda Caicedo, an infectious disease specialist at Hospital Universitario del Valle in Cali, Colombia, who is treating the latest survivor, confirmed reports in the Colombian newspaper El País that the victim is an eight-year-old girl who came down with symptoms in August, about a month after she was bitten by an apparently rabid cat.

Caicedo said that the family had sought treatment for the bite in Bolivar, at a hospital about three hours by foot from their rural home, but that the child, Nelsy Gomez, did not receive the series of vaccines that can prevent the virus from turning into full-blown rabies. The five shots contain minute amounts of the dead rabies virus and are designed to nudge the body into developing antibodies to fight it. Patients are also given a shot of immunoglobulin (in this case a synthesized rabies antibody) to protect them while their immune systems produce antibodies to the vaccine virus. But the combination is only effective within six days of infection, before symptoms show up; when Gomez developed signs of the disease, it was too late for the shots. With no other options available, doctors induced a coma. Caicedo is hopeful, but indicated that Gomez will face a long, slow recovery. She would not say how long Gomez was comatose but told ScientificAmerican.com that she had been awake for "a few days" and is stable. The child can move her fingers but cannot walk or eat on her own, and her eyes are open but she cannot speak yet and physicians are not sure if she can see, Caicedo says.

Giese, informed of the case, says that she "hopes and prays" that Gomez will survive. Giese was the keynote speaker at a conference last week in Atlanta, where scientists gathered to discuss the latest research being conducted on ways to battle the deadly disease. During her talk, she urged physicians to continue efforts to pin down treatments that work. Giese was 15 when she was infected after being bitten by a rabid bat she had picked up outside her church in her hometown of Fond du Lac, Wisc. Her parents cleaned the superficial wound and she says they did not believe it was necessary to seek further medical treatment. "We never thought of rabies," she says. By the time Giese began displaying signs of rabies three weeks later—fatigue, double vision, vomiting and tingling in her left arm—it was too late for the antirabies vaccine cocktail. Instead of giving her up for dead, the doctors decided to "shut the brain down and wait for the cavalry to come" by inducing a coma to give her own immune system time to build up antibodies against the virus, says Rodney Willoughby , an infectious disease specialist who treated Giese at the Children's Hospital of Wisconsin in Milwaukee.

Willoughby devised the treatment credited with saving Giese there, which has since become known as the Milwaukee protocol. Rabies kills by compromising the brain's ability to regulate breathing, salivation and heartbeat; ultimately, victims drown in their own spit or blood, or cannot breathe because of muscle spasms in their diaphragms. One fifth die from fatal heart arrhythmia. Doctors believed that Giese might survive if they suppressed her brain function by sedating her while her immune system attacked the rabies virus. This was the first time the therapy was attempted, and doctors had no clue if it would work or, if it did, whether it would leave her brain damaged. But Willoughby says it was the only chance doctors had of saving her. When she arrived at the hospital, Giese couldn't talk, sit or stand and fell in and out of consciousness—she also needed to be intubated to help her breathe. "She was critically ill," Willoughby recalls, "and looked as if she might die within the day." In addition to inducing the coma, doctors also gave her the antivirals ribavarin and amantadine.

They tapered off the anesthetics after about a week, when tests showed that Giese's immune system was battling the virus. For about six months after awakening from the coma, physicians also gave her a compound called tetrahydrobiopterin that is chemically similar to the B-complex vitamin folic acid, which may have improved her speech and ability to eat, Willoughby says. He notes that physicians gave her the supplement after tests showed that she had a deficiency of the compound, which is known to boost production of serotonin and dopamine neurotransmitters needed to perform motor, speech and other routine bodily functions. Remarkably, Giese survived. She recovered most of her cognitive functions within a few months, and other skills within a year, Willoughby says. She got her driver's license and is now a sophomore at Marian University in Fond du Lac, where she is majoring in biology. There are lingering signs of her illness: Giese, once an avid athlete, says she now lists to one side when she runs and walks and no longer plays volleyball, basketball and softball as she once did. She also speaks more slowly and sometimes not as clearly as before her illness, but Willoughby says these effects may fade over time.

Giese is " pretty much normal ," says Willoughby, an associate professor of pediatrics at the Medical College of Wisconsin in Milwaukee. "She continues to get better, counter to conventional medical thinking." Rabies has an incubation period of two weeks to three months and kills within a week of the symptoms showing up. The vaccine series and other immune therapies are useless at this point and may even speed up and increase the severity of the symptoms. Usually, patients are made as comfortable as possible in the hospital or, in countries without sophisticated health care, sent home to die an agonizing death. Antiviral drugs and immune therapies including steroids, disease-fighting interferon-alpha and poly IC (which stimulates the body's own production of interferon-alpha) have been tried, but none have been shown to be lifesaving on their own, Willoughby says. Over the past four years, the Milwaukee protocol to differing degrees has been used a dozen times, but until now Giese was the sole survivor. Exactly why she lived—and the others died—is still a mystery. In a 2005 report on her case in The New England Journal of Medicine , Willoughby speculated that she may have been infected with a rare, weakened version of the virus.

Today, he chalks Giese's survival up to aggressive intensive care, the decision to sedate her "and 10 percent sheer luck." Which element of that combination made the difference, and whether the antivirals she was given helped save her is unknown. "In all honesty, we were probably just pretty lucky," he says. Only another survivor, and then animal and clinical trials, will show if the therapy works, and why, he says. The U.S. Centers for Disease Control and Prevention (CDC) plans to test the protocol on rabies-infected ferrets; Thai and Canadian doctors, who unsuccessfully treated a 33-year-old man with rabies with the Milwaukee protocol, recommended in the Journal of NeuroVirology two years ago that physicians exercise "caution" in using the treatment, because it is too expensive and lacks " a clear scientific rationale." Willoughby says it cost about $800,000 to treat Giese. Rabies is 100 percent preventable with vaccinations if patients receive them before the onset of symptoms, including hallucinations, delirium, muscle spasms, paralysis and hydrophobia.

Yet an estimated 55,000 people, mostly in Asia and Africa, die from it annually because of misdiagnosis or because the illness is not recognized until it has taken hold, according to the journal Neurologic Clinics. Often, patients dismiss the potential seriousness of bites, cannot afford follow-up medical treatment or, in some situations, are unaware they've been bitten, as was the case of a 13-year-old Connecticut girl who died of rabies in 1995 . Vaccine shortages as one manufacturer, Bridgewater, N.J.–based sanofi–aventis, upgrades its factory to meet U.S. Food and Drug Administration requirements , and chronic shortfalls of immunoglobulin also play a role in the fatalities. The vaccine-immunoglobulin regimen costs $1,200 to $2,000 in industrialized nations and $100 to $300 in developing countries—an out-of-reach sum for many people, Willoughby says.

Though it's promising that Gomez is still alive, "The hope that the outcome will necessarily be the same as with Jeanna, particularly in a developing country, is expecting a bit much," laments Charles Rupprecht, chief of the CDC's Rabies Program Willoughby acknowledges that even if Giese's success is reproducible—and the Milwaukee protocol perfected—it likely will only be available for use in 10 percent of cases, because of limited medical facilities in developing countries. "Re-creating that in a place stricken with poverty, you get into ethical issues of whether we should do this when we should be about prevention; and does that society have the ability to rehabilitate a patient who may survive but with severe [side effects]?" Rupprecht says. "Jeanna created several ethical issues for all of us to deal with this bug." Giese says that the fourth-year anniversary of her illness has brought up some bitter memories that she'll probably never shake, but she's glad to be alive—and doing as well as she is. "It takes some getting used to, but I've kind of come to terms with the fact that I'm the only…[survivor]," she says.

"At 15, I never would have thought that anything like this would ever happen, and that I lived is just amazing." An animal lover who owns a dog, two rabbits and six birds, she hopes to one day open a sanctuary in Fond du Lac for endangered animals, including "big predators like lions and tigers and wolves," and maybe even bats , too. "I'm not scared of them at all," Giese says of bats. "I'm more passionate about animals than I was before. Animals are my happiness and reason for living." Additional reporting by Barbara Juncosa Rabies - Symptoms, Diagnosis, Treatment of Rabies - NY Times Health Information Back to Top Causes Rabies is spread by infected saliva that enters the body through a bite or broken skin. The virus travels from the wound to the brain, where it causes swelling, or inflammation. This inflammation leads to symptoms of the disease. Most rabies deaths occur in children. In the past, human cases in the United States usually resulted from a dog bite, but recently, more cases of human rabies have been linked to bats and raccoons.

Although dog bites are a common cause of rabies in developing countries, there have been no reports of rabies caused by dog bites in the United States for a number of years due to widespread animal vaccination. Other wild animals that can spread the rabies virus include: Foxes Skunks Very rarely, rabies has been transmitted without an actual bite. This is believed to have been caused by infected saliva that has gotten into the air, usually in bat caves. The United Kingdom had once completely eradicated rabies, but recently, rabies-infected bats have been found in Scotland. The actual time between infection and when you get sick ranges from 10 days - 7 years. This is called the incubation period. The average period is 3 - 12 weeks. Symptoms may include: Back to Top Exams and Tests If an animal bites you, try to gather as much information about the animal as possible. Call your local animal control authorities to safely capture the animal. If rabies is suspected, the animal will be watched for signs of rabies. A special test called immunofluorescence is used to look at the brain tissue after an animal is dead. This test can reveal whether or not the animal had rabies.

The doctor or nurse will examine you and look at the bite. The wound will be cleaned and treated as appropriate. The same test used on animals can be done to check for rabies in humans, using a piece of skin from the neck. Doctors may also look for the rabies virus in your saliva or spinal fluid, although these tests are not as sensitive and may need to be repeated. A spinal tap may be done to look for signs of the infection in your spinal fluid Back to Top Treatment Clean the wound well with soap and water, and seek professional medical help. You'll need a doctor to thoroughly clean the wound and remove any foreign objects. Most of the time, stitches should not be used for animal bite wounds. If there is any risk of rabies, you will be given a series of a preventive vaccine. This is generally given in 5 doses over 28 days. Most patients also receive a treatment called human rabies immunoglobulin (HRIG). This is given the day the bite occurred. Call your doctor right away after an animal bite or after being exposed to animals such as bats, foxes, and skunks. They may carry rabies. Call even when no bite took place.

Immunization and treatment for possible rabies are recommended for at least up to 14 days after exposure or a bite. There is no known effective treatment for people with symptoms of a rabies infection. Back to Top Outlook (Prognosis) It's possible to prevent rabies if immunization is given soon after the bite. To date, no one in the United States has developed rabies when given the vaccine promptly and appropriately. Once the symptoms appear, the person rarely survives the disease, even with treatment. Death from respiratory failure usually occurs within 7 days after symptoms start. Untreated, rabies can lead to coma and death. In rare cases, some people may have an allergic reaction to the rabies vaccine. Back to Top When to Contact a Medical Professional Go to the emergency room or call the local emergency number (such as 911) if an animal bites you. To help prevent rabies: Avoid contact with animals you don't know. Get vaccinated if you work in a high-risk occupation or travel to countries with a high rate of rabies. Make sure your pets receive the proper immunizations. Ask your veterinarian. Follow quarantine regulations on importing dogs and other mammals in disease-free countries.

Back to Top References Rupprecht CE, Briggs D, Brown CM, et al. Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep . 2010 Mar 19;59(RR-2):1-9. Erratum in: MMWR Recomm Rep . 2010 Apr 30;59(16):493. Bassin SL, Rupprecht CE, Bleck TP. Rhabdoviruses. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases . 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 163. More Information on This Topic News & Features Review Date: 8/14/2012 Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Jatin M.

Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation ( A.D.A.M. Copyright The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc.

Any duplication or distribution of the information contained herein is strictly prohibited.

Question: The disease hydrophobia is better known as what?
Answer: Rabies